Provider Demographics
NPI:1467521203
Name:ATLAS CHIROPRACTIC AND WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC AND WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOCCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-518-1234
Mailing Address - Street 1:10931 STRICKLAND RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2085
Mailing Address - Country:US
Mailing Address - Phone:919-518-1234
Mailing Address - Fax:919-518-0878
Practice Address - Street 1:10931 STRICKLAND RD
Practice Address - Street 2:SUITE 131
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2085
Practice Address - Country:US
Practice Address - Phone:919-518-1234
Practice Address - Fax:919-518-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U58789Medicare UPIN
2449782BMedicare PIN